What's Behind This Tension Pneumothorax?

​BY KYLE NADEL & PAUL SILKA, MDThe older woman was short of breath and experiencing epigastric abdominal pain. She was an ex-smoker in her mid-70s with a past medical history of COPD, pulmonary fibrosis, breast cancer, and intermittent home oxygen. Her symptoms had started gradually a few hours earlier.The patient's vital signs on arrival were a blood pressure of 122/80 mm Hg, heart rate of 101 bpm, respiratory rate of 42 bpm, and 91% SpO2 on 2 L/min via nasal cannula. She was tachypneic with accessory muscle use, and breath sounds were clear bilaterally but diminished on the left hemithorax.The patient was promptly placed on continuous oxygen therapy via nonrebreather mask, and routine blood work was initiated. A chest x-ray revealed a left-sided pneumothorax, prompting the emergency physician to perform an anterior tube thoracostomy with a 19 French pigtail catheter placed in the fifth intercostal space at the midclavicular line. The pigtail catheter was attached to a Heimlich valve for air drainage without negative pressure or suction and secured with prefabricated adhesive dressing.The patient was admitted to a post-procedure telemetry bed after a repeat chest x-ray demonstrated improvement of the left pneumothorax, but the patient developed worsening respiratory distress with oxygen saturation falling below 80% about seven hours after insertion of the catheter. (Figure 1.) Her heart rate also increased as she developed hypotension with absent breath sounds ips...
Source: The Case Files - Category: Emergency Medicine Tags: Blog Posts Source Type: research